Key result
Shorter membranous septum length linked to increased risk of new PPI 30 days after TAVR.
Why the study?
Although a short membranous septum length is linked to new permanent pacemaker implantation after TAVR with self-expanding valves, this relationship has not been investigated across different currently available transcatheter heart valve platforms.
Does membranous septum length predict the need for new permanent pacemaker implantation in patients undergoing TAVR with different valve platforms?
Observational (n=1,811)
Does membranous septum length predict the need for new permanent pacemaker implantation in patients undergoing TAVR with different valve platforms?
Membranous septum length is an independent predictor of the need for a new permanent pacemaker after TAVR with Sapien3 and Evolut valves, suggesting that anatomy-tailored valve selection could mitigate this risk.
Shorter MS length associated with higher new-PPI risk after TAVR; hypothesis-generating for anatomy-guided valve selection pending prospective validation.
BACKGROUND: New permanent pacemaker implantation (new-PPI) remains a compelling issue after Transcatheter Aortic Valve Replacement (TAVR). Previous studies reported the relationship between a short MS length and the new-PPI post-TAVR with a self-expanding THV. However, this relationship has not been investigated in different currently available THV. Therefore, the aim of this study was to investigate the association between membranous septum (MS)-length and new-PPI after TAVR with different Transcatheter Heart Valve (THV)-platforms. METHODS: We included patients with a successful TAVR-procedure and an analyzable pre-procedural multi-slice computed tomography. MS-length was measured using a standardized methodology. The primary endpoint was the need for new-PPI within 30 days after TAVR. RESULTS: In total, 1811 patients were enrolled (median age 81.9 years [IQR 77.2-85.4], 54% male). PPI was required in 275 patients (15.2%) and included respectively 14.2%, 20.7% and 6.3% for Sapien3, Evolut and ACURATE-THV(p < 0.01). Median MS-length was significantly shorter in patients with a new-PPI (3.7 mm [IQR 2.2-5.1] vs. 4.1 mm [IQR 2.8-6.0], p = <0.01). Shorter MS-length was a predictor for PPI in patients receiving a Sapien3 (OR 0.87 [95% CI 0.79-0.96], p = <0.01) and an Evolut-THV (OR 0.91 [95% CI 0.84-0.98], p = 0.03), but not for an ACURATE-THV (OR 0.99 [95% CI 0.79-1.21], p = 0.91). By multivariable analysis, first-degree atrioventricular-block (OR 2.01 [95% CI 1.35-3.00], p = <0.01), right bundle branch block (OR 8.33 [95% CI 5.21-13.33], p = <0.01), short MS-length (OR 0.89 [95% CI 0.83-0.97], p < 0.01), annulus area (OR 1.003 [95% CI 1.001-1.005], p = 0.04), NCC implantation depth (OR 1.13 [95% CI 1.07-1.19] and use of Evolut-THV(OR 1.54 [95% CI 1.03-2.27], p = 0.04) were associated with new-PPI. CONCLUSION: MS length was an independent predictor for PPI across different THV platforms, except for the ACURATE-THV. Based on our study observations within the total cohort, we identified 3 risk groups by MS length: MS length ≤3 mm defined a high-risk group for PPI (>20%), MS length 3-7 mm intermediate risk for PPI (10-20%) and MS length > 7 mm defined a low risk for PPI (<10%). Anatomy-tailored-THV-selection may mitigate the need for new-PPI in patients undergoing TAVR.
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Hokken et al. (2022) conducted an observational in Patients undergoing Transcatheter Aortic Valve Replacement (TAVR) (n=1,811). Membranous septum length was evaluated on Need for new permanent pacemaker implantation (new-PPI) within 30 days after TAVR (OR 0.89, 95% CI 0.83-0.97, p=<0.01). Shorter membranous septum length was an independent predictor for new permanent pacemaker implantation within 30 days after TAVR (OR 0.89; 95% CI 0.83-0.97; p<0.01).
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